Search

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive–Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). Method: A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. Result: This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. Conclusion: It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive–Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008. Method: A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments. Result: The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD (n = 291) and PTSD (n = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders. For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs. Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated. For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option. Conclusion: OCD and PTSD can be effectively treated with CBT and medications.

A meta‐analysis was performed to examine therapeutic effects of Silexan on somatic symptoms, including insomnia/fatigue, and physical health in patients with anxiety disorders. Five randomized, placebo‐controlled trials were included in this analysis: The efficacy of Silexan (80 mg/day) was investigated in patients with subthreshold anxiety disorders (three trials) and in patients with generalized anxiety disorder (two trials). Silexan was superior to placebo in terms of the mean change from baseline in the Hamilton Anxiety Rating Scale (HAMA) subscore somatic anxiety at week 10 with a standardized mean difference of −0.31 [95% Cl: −0.52 to −0.10, p = .004]. Treatment effects of silexan on somatic anxiety were independent of gender and age. Statistically significant differences were also shown for single HAMA items somatic muscular, cardiovascular, respiratory, and genitourinary symptoms, indicating clinical relevance with small to medium effects of Silexan. Similar clinically meaningful effects of Silexan on SF‐36 physical health, including reduced bodily pain and improved general health, and on insomnia complaints and fatigue, were demonstrated. In this meta‐analysis including all placebo‐controlled clinical trials in patients with anxiety disorders to date, statistically significant and clinically meaningful advantages of Silexan over placebo treatment were found in improving somatic symptoms and physical health., In this meta‐analysis including all placebo‐controlled clinical trials in patients with anxiety disorders to date, statistically significant and clinically meaningful advantages of Silexan over placebo treatment were found in improving somatic symptoms and physical health.

BackgroundObsessive–compulsive disorder (OCD) has been linked to functional abnormalities in fronto-striatal networks as well as impairments in decision making and learning. Little is known about the neurocognitive mechanisms causing these decision-making and learning deficits in OCD, and how they relate to dysfunction in fronto-striatal networks.MethodWe investigated neural mechanisms of decision making in OCD patients, including early and late onset of disorder, in terms of reward prediction errors (RPEs) using functional magnetic resonance imaging. RPEs index a mismatch between expected and received outcomes, encoded by the dopaminergic system, and are known to drive learning and decision making in humans and animals. We used reinforcement learning models and RPE signals to infer the learning mechanisms and to compare behavioural parameters and neural RPE responses of the OCD patients with those of healthy matched controls.ResultsPatients with OCD showed significantly increased RPE responses in the anterior cingulate cortex (ACC) and the putamen compared with controls. OCD patients also had a significantly lower perseveration parameter than controls.ConclusionsEnhanced RPE signals in the ACC and putamen extend previous findings of fronto-striatal deficits in OCD. These abnormally strong RPEs suggest a hyper-responsive learning network in patients with OCD, which might explain their indecisiveness and intolerance of uncertainty.

Social anxiety disorder (SAD) is the most common anxiety disorder and has considerable negative impact on social functioning, quality of life, and career progression of those affected. Gelotophobia (the fear of being laughed at) shares many similarities and has therefore been proposed as a subtype of SAD. This hypothesis has, however, never been tested in a clinical sample. Thus, the relationship between gelotophobia, SAD and avoidant personality disorder (APD) was investigated by examining a sample of 133 participants (64 psychiatric patients and 69 healthy controls matched for age and sex) using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th edition) and an established rating instrument for gelotophobia (GELOPH). As expected, gelotophobia scores and the number of gelotophobic individuals were significantly higher among patients with SAD (n = 22) and APD (n = 12) compared to healthy controls and other psychiatric patients. Furthermore, gelotophobia scores were highest in patients suffering from both SAD and APD. In fact, all patients suffering from both disorders were also suffering from gelotophobia. As explained in the discussion, the observed data did not suggest that gelotophobia is a subtype of SAD. The findings rather imply that the fear of being laughed at is a symptom characteristic for both SAD and APD. Based on that, gelotophobia may prove to be a valuable additional diagnostic criterion for SAD and APD and the present results also contribute to the ongoing debate on the relationship between SAD and APD., PLoS ONE, 12 (11), ISSN:1932-6203

Ces recommandations de traitement de la Societe suisse des troubles anxieux et de la depression et de la Societe suisse de psychiatrie biologique ont ete elaborees conjointement avec la Societe suisse de psychiatrie et psychotherapie suivant les lignes directrices de la «World Federation of Societies of Biological Psychiatry» et de la «Deutsche Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde».

Diese Behandlungsempfehlungen der Schweizerischen Gesellschaft fur Angst und Depression und der Schweizerischen Gesellschaft fur Biologische Psychiatrie wurden in Zusammenarbeit mit der Schweizerischen Gesellschaft fur Psychiatrie und Psychotherapie auf der Grundlage der Leitlinien der «World Federation of Societies of Biological Psychiatry» und der Deutschen Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde erstellt.

Diese Behandlungsempfehlungen der Schweizerischen Gesellschaft fur Angst und Depression und der Schweizerischen Gesellschaft fur Biologische Psychiatrie wurden in Zusammenarbeit mit der Schweizerischen Gesellschaft fur Psychiatrie und Psychotherapie auf der Grundlage von Leitlinien der «World Federation of Societies of Biological Psychiatry» und der Deutschen Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde erstellt.

Burnout manifestiert sich als Erschopfungszustand mit psychischen, vegetativen, kognitiven und Verhaltensbezogenen Symptomen und weist eine hohe Uberlappung mit psychiatrischen und somatischen Storungen auf. Die Behandlung erfolgt multimodal und berucksichtigt die verschiedenen verursachenden Faktoren.

Le burnout se manifeste sous forme d’etat d’epuisement accompagne de symptomes psychiques, vegetatifs, cognitifs et comportementaux, et il presente de forts recoupements avec les troubles psychiatriques et somatiques. Le traitement est multimodal et tient compte des differents facteurs causaux.

Burnout ist ein stressbedingtes Erschopfungssyndrom, das im Kontext einer chronischen Stressbelastung am Arbeitsplatz entsteht und einen Risikozustand fur psychiatrische und somatische Folgeerkrankungen darstellt.

Le burnout est un syndrome d’epuisement lie au stress, qui survient dans le cadre d’un stress chronique sur le lieu de travail et constitue un facteur de risque de maladies psychiatriques et somatiques subsequentes.

Diese Behandlungsempfehlung orientiert sich an der internationalen Leitlinie der World Federation of Societies of Biological Psychiatry (WFSBP) [1] und der S3-Leitlinie / Nationalen Versorgungsleitlinie der Deutschen Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) [2] und fasst die evidenzbasierten Therapiestrategien (neuester Stand der wissenschaftlichen Erkenntnisse nach den Kriterien der evidenzbasierten Medizin) zur akuten Behandlung der depressiven Episoden nach den Kriterien der «International Classification of Diseases» (ICD-10, WHO 1992) sowie des «Diagnostic and Statistical Manual of Mental Disorders» (DSM-IV) zusammen. Die Behandlungsempfehlung setzt eine grundliche diagnostische Abklarung durch eine arztliche Fachperson voraus, wobei andere psychische sowie somatische Erkrankungen ausgeschlossen und depressionsauslosende Faktoren (z.B. Medikamente, psychosoziale Stressfaktoren usw.) berucksichtigt werden mussen. Die vier Grundelemente der psychiatrischen Behandlung (aktiv abwartende Begleitung, medikamentose und psychotherapeutische Behandlungen sowie Kombinationstherapie) sollten wahrend der gesamten Behandlung angemessen unter Berucksichtigung von klinischen Faktoren wie Symptomschwere, Erkrankungsverlauf und Patientenpraferenz eingesetzt werden. Der Behandlungsplan richtet sich in erster Linie nach dem Schweregrad der Depression (Abb. 1 x). Eine aktiv abwartende Begleitung (watchful waiting) kann bei Patienten mit leichter depressiver Episode genugen. Jedoch sollte die Besserung der Symptomatik innerhalb der ersten beiden Wochen uberpruft werden. Antidepressiva sollten nicht generell zur Erstbehandlung von leichten depressiven Episoden eingesetzt werden, sondern nur nach kritischer Abwagung des Nutzen-Risiko-Verhaltnisses. Das berucksichtigt u.a. den Wunsch des Patienten, positives Ansprechen in der Vergangenheit, Fortbestehen von Symptomen nach anderen Interventionen sowie mittelgradige oder schwere Depressionen in der Vorgeschichte. Zur Behandlung von leichten bis mittelschweren Depressionen soll eine angemessene Psychotherapie angeboten werden. Der Einsatz von Antidepressiva ist insbesondere bei mittelgradigen und schweren depressiven Episoden indiziert. Ein wesentliches Behandlungsmoment ist die vertrauensvolle Beziehung zwischen Patient und Behandler, weshalb jede Pharmakotherapie in ein entsprechendes Gesprachsangebot eingebettet gehort. Der Evidenzgrad der einzelnen Therapien wird in Stufen (Level A bis D) angegeben (Tab. 1 p). Methodische Kriterien bestimmen die Evidenz, d.h. die Bewertung der Wirksamkeit einer Intervention basiert in der Regel auf randomisierten klinischen Studien (RCT). Aus dem Fehlen von RCT fur einzelne Behandlungen kann aber nicht der Ruckschluss gezogen werden, dass diese Verfahren nicht wirksam sind. Die psychiatrische Theorie und Praxis beruht in der Schweiz auf einem biopsychosozialen Ansatz in der Diagnostik und Behandlung psychischer Storungen (vgl. Weiterbildungsprogramm und Leitbild der SGPP). Entsprechend werden erganzend zu den vorliegenden evidenzbasierten somatischen Behandlungsempfehlungen auch Empfehlungen fur die Psychotherapie der Depression inklusive dem sozialen Blickwinkel (soziales Netz, Arbeitsfahigkeit usw.) mit der SGPP als Herausgeberin erarbeitet und veroffentlicht.

Cette recommandation de traitement suit les lignes directrices internationales de la World Federation of Societies of Biological Psychiatry (WFSBP) [1] et nationale S3 de la Deutsche Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) [2]. Elle reprend les strategies basees sur des preuves (l’ensemble des dernieres connaissances scientifiques selon les criteres de la medecine basee sur des preuves) du traitement aigu des episodes depressifs selon les criteres de l’«International Classification of Diseases» (ICD-10, OMS 1992) et du «Diagnostic and Statistical Manual of Mental Disorders» (DSM-IV). Cette recommandation de traitement presuppose un diagnostic approfondi par un medecin, avec exclusion d’autres maladies psychiques et somatiques, et en tenant compte des facteurs declenchant une depression (par ex. medicaments, stress psychosocial, etc.). Les quatre elements fondamentaux du traitement psychiatrique (accompagnement expectatif actif, traitements medicamenteux, psychotherapeutiques et combines) doivent etre exploites de maniere appropriee pendant toute la duree du traitement et en tenant compte de facteurs cliniques tels que la gravite des symptomes, l’evolution de la maladie et la preference du patient. Le plan de traitement est fait en fonction d’abord de la gravite de la depression (fig. 1 x). Un accompagnement expectatif actif (watchful waiting) peut suffire pour des patients presentant des episodes depressifs legers. Mais l’amelioration de la symptomatologie doit se confirmer au cours des deux premieres semaines. Les antidepresseurs ne doivent pas etre utilises de maniere generale pour le premier traitement d’episodes depressifs legers mais uniquement apres avoir soigneusement pese le rapport beneficerisque. Cela tient compte notamment du souhait du patient, d’une reponse positive anterieure, de la persistance de symptomes apres d’autres interventions et de l’anamnese de depressions moderees ou graves. Une psychotherapie adequate doit etre proposee pour le traitement de depressions legeres a moderees. Les antidepresseurs sont particulierement indiques dans les episodes depressifs moderes et graves. Un moment therapeutique essentiel est la relation de confiance entre le patient et le soignant, raison pour laquelle toute pharmacotherapie doit etre englobee dans une proposition adequate de discussion. Le niveau d’evidence de chaque traitement est donne en paliers (level A a D) (tab. 1 p). Les criteres methodologiques determinent l’evidence, c’est-a-dire que l’evaluation de l’efficacite d’une intervention se base generalement sur des etudes cliniques randomisees (RCT). Il ne faut toutefois pas conclure de l’absence de RCT pour tel ou tel traitement qu’il n’est pas efficace. La theorie et la pratique psychiatriques reposent en Suisse sur une evaluation biopsychosociale dans le diagnostic et le traitement des troubles psychiques (c.f. programme de formation postgraduee et modele de la SSPP). En complement de ces recommandations de traitement somatique basees sur des preuves sont redigees et publiees des recommandations pour la psychotherapie de la depression sous l’angle social (reseau social, capacite de travail, etc.) avec la SSPP comme editrice.

Although detoxification cannot, in itself, be considered a treatment for addiction, it is one of the most pivotal phases. In order to facilitate entry into recovery and/or rehabilitation programs, a detoxification treatment has to be experienced as easy and safe by the patient. In consideration of the many inconveniences related to standard withdrawal treatments, there is an interest in developing alternative pharmacological strategies. The main rationales for using anticonvulsants in substance-abuse patients are their lack of addiction potential, evidence support a role of kindling mechanisms in withdrawal syndromes and their efficacy in comorbid psychiatric disorders. The available data currently support the utilization of carbamazepine as a treatment for detoxification from benzodiazepines, alcohol and opiates, and as a useful agent to reduce cocaine consumption. The use of valproate is well corroborated for alcohol detoxification and it seems to be a promising treatment for the reduction of cocaine use; however, it has been found to be ineffective against benzodiazepine withdrawal symptoms. Some preliminary data suggest that lamotrigine could be useful in opiate and cocaine dependence. Gabapentin shows potential as a treatment for cocaine dependence, and some case reports have stimulated interest in this agent for alcohol and benzodiazepine detoxification. Due to its particular pharmacological profile, topiramate is one of the most interesting newer anticonvulsants. It has been found to be efficacious in opiate and possibly benzodiazepine detoxification and also has theoretical potential as a preventive therapy.

Converging evidence suggests that a single sub-anesthetic dose of ketamine can produce strong and rapid antidepressant effects in patients that do not respond to standard treatment. Despite a considerable amount of research investigating ketamine's mechanisms of action, the exact neuronal targets conveying the antidepressant effects have not been identified yet. Preclinical studies suggest that molecular changes induced by ketamine bring forward large-scale network reconfigurations that might relate to ketamine's antidepressant properties. In this prospective two-site study we measured resting state fMRI in 24 depressed patients prior to, and 24 h after a single sub-anesthetic dose of ketamine. We analyzed functional connectivity (FC) at baseline and after ketamine and focused our analysis on baseline FC and FC changes directly linked to symptom reduction in order to identify neuronal targets that predict individual clinical responses to ketamine. Our results show that FC increases after ketamine between right lateral prefrontal cortex (PFC) and subgenual anterior cingulate cortex (sgACC) are positively linked to treatment response. Furthermore, low baseline FC between these regions predicts treatment outcome. We conclude that PFC-sgACC connectivity may represent a promising biomarker with both predictive and explanatory power.

Les depressions sont des maladies graves qui affectent negativement les fonctions psychiques, physiques et sociales. Peu observees chez des enfants, les depressions sont en revanche frequentes chez les adolescents. - Un symptome de nombreuses depressions qui menace la survie du patient est la suicidalite. - La plupart des suicides et tentatives de suicide sont a mettre au compte d'une absence ou d'une insuffisance de traitement. - Un diagnostic precoce et un traitement approprie de l'episode depressif sont la meilleure prevention du suicide. - Il est scientifiquement prouve que les antidepresseurs entrainent une remission des episodes depressifs et diminuent le risque de rechute. - La levee de l'inhibition dans le cadre de l'amelioration et les effets indesirables des antidepresseurs modernes dans la phase initiale du traitement (pendant les 1-2 premiers mois surtout) peuvent l'un et l'autre favoriser des symptomes suicidaires, mais n'augmentent pas le nombre de suicides. - Les impulsions suicidaires peuvent etre reduites par un bref traitement de l'agitation, des etats de tension et d'anxiete et des insomnies par des benzodiazepines. - Etant donne que l'effet releveur d'humeur des antidepresseurs n'intervient qu'au bout d'une a deux semaines, les patients traites doivent etre etroitement surveilles et pris en charge pendant cette periode. Ceci vaut egalement pour une psychotherapie menee seule ou en association a un autre traitement. - Selon les analyses les plus recentes, la Food and Drug Administration (FDA) des Etats-Unis ne voit aucune raison d'interdire les inhibiteurs selectifs de la recapture de la serotonine (ISRS) dans le traitement des enfants, des adolescents et des jeunes adultes. - La prescription d'antidepresseurs a des enfants et des adolescents ne doit se faire qu'apres une evaluation consciencieuse de l'indication et des autres possibilites; elle reste neanmoins une option therapeutique importante. - Le traitement antidepresseur de l'enfant et de l'adolescent est du ressort du specialiste et doit avoir lieu en milieu hospitalier en cas de forte suicidalite dans la phase de stabilisation, en particulier apres des tentatives de suicide anterieures. - Une depression non traitee est le plus grand facteur de risque de suicide. Des patients depressifs ne doivent pas, en raison d'une discussion non objective et unilaterale de leur cas, etre prives d'un traitement antidepresseur souvent salutaire.